Skip to main content

Advertisement

SpringerLink
Log in

Predictors of Over-Reporting HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Young Men Who Have Sex With Men (YMSM) in Self-Reported Versus Biomarker Data

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Young men who have sex with men (YMSM) face a disproportionately high burden of HIV. Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition, but adherence to PrEP among YMSM may be inadequate. Medication adherence may be assessed via biomarkers, which are expensive and invasive, or via self-report through Audio Computer Assisted Self-Interview (ACASI), which may result in over-reporting of adherence. In this paper we assess the potential of a new method of self-report, the Interactive Questionnaire System (iQS), in validly estimating true adherence rates. PrEP adherence among 167 YMSM aged 15–23 was measured via dried blood spot (DBS), ACASI, and iQS twice over a 24-week study period. Both ACASI- and iQS-reported data revealed that over 40% of individuals self-reporting adequate PrEP adherence had DBS-estimated drug levels indicating inadequate adherence. Adjusted logistic repeated measures random intercept regression analyses indicated that younger YMSM had higher odds of over-reporting adherence than older YMSM—each 1 year increase in age was associated with 0.79 times the odds of over-reporting adherence (95% CI 0.63, 0.98; p value = 0.031), and being African American was associated with 3.22 times greater odds of over-reporting than non-African Americans (95% CI 1.51, 6.90; p-value = 0.0003). These results suggest that ACASI and iQS methods of self-report significantly overestimate true PrEP adherence rates among YMSM, and that the odds of over-reporting adherence may be affected by both age and race.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Estimated HIV Incidence in the United States, 2007–2010. CDC HIV Surveill Rep. 2012;17(4). http://www.cdc.gov/hiv/pdf/statistics_hssr_vol_17_no_4.pdf.

  2. HIV Surveillance Report: diagnoses of HIV infection in the United States and dependent areas, 2014; 26. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf.Accessed 3 Jan 2017.

  3. Black D, Gates G, Sanders S, Taylor L. Demographics of the gay and lesbian population in the United States: evidence from available systematic data sources. Demography. 2000;37(2):139–54.

    Article  CAS  PubMed  Google Scholar 

  4. CDC FACT SHEET: HIV among Gay and Bisexual Men. 2016. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf. Accessed 3 Jan 2017.

  5. Mustanski BS, Newcomb ME, Bois SND, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48(2–3):218–53.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;. https://doi.org/10.1126/scitranslmed.3004006.

    Google Scholar 

  8. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV-1 prevention among heterosexual men and women. N Engl J Med. 2012;367(5):399–410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Grant RM, Anderson PL, McMahan V, Liu A, Amico KR, Mehrotra M, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.

    Article  PubMed  Google Scholar 

  10. Celum C, Baeten J. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evidence and evolving questions. Curr Opin Infect Dis. 2012;25(1):51–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2012;17(6):2162–72.

    Article  Google Scholar 

  12. Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among african women. N Engl J Med. 2015;372(6):509–18.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hosek S, Siberry G, Bell M, Lally M, Kapogiannis B, Green K, et al. Project PrEPare (ATN082): the acceptability and feasibility of an HIV pre-exposure prophylaxis (PrEP) trial with young men who have sex with men (YMSM). J Acquir Immune Defic Syndr. 1999;. https://doi.org/10.1097/QAI.0b013e3182801081.

    Google Scholar 

  14. Corneli AL, Deese J, Wang M, Taylor D, Ahmed K, Agot K, et al. FEM-PrEP: adherence patterns and factors associated with adherence to a daily oral study product for pre-exposure prophylaxis. JAIDS J Acquir Immune Defic Syndr. 2014;66(3):324–31.

    Article  CAS  PubMed  Google Scholar 

  15. Amico KR, Marcus JL, McMahan V, Liu A, Koester KA, Goicochea P, et al. Study product adherence measurement in the iPrEx placebo-controlled trial: Concordance with drug detection. J Acquir Immune Defic Syndr (1999). 2014;66(5):530–7.

    Article  CAS  Google Scholar 

  16. Amico KR, Stirratt MJ. Adherence to preexposure prophylaxis: current, emerging, and anticipated bases of evidence. Clin Infect Dis. 2014;59(suppl_1):S55–60.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rudy B, Murphy D, Harris R, Muenz L, Ellen J. Patient-related risks for nonadherence to antiretroviral therapy among HIV-infected youth in the United States: a study of prevalence and interactions. AIDS Patient Care STDs. 2009;23:185–94.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hosek S, Rudy B, Landovitz R, Kapogiannis B, Siberry G, Rutledge B, et al. An HIV preexposure prophylaxis demonstration project and safety study for young MSM. J Acquir Immune Defic Syndr. 2017;74(1):21–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gorbach PM, Mensch BS, Husnik M, Coly A, Mâsse B, Makanani B, et al. Effect of computer-assisted interviewing on self-reported sexual behavior data in a microbicide clinical trial. AIDS Behav. 2012;17(2):790–800.

    Article  Google Scholar 

  20. Greenland S. Model and variable selection in epidemiologic analysis. Am J Public Health. 1989;79:340–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ford CV. Lies! lies‼ lies‼!: The psychology of deceit. American Psychiatric Pub; 1999. https://books.google.com/books?hl=en&lr=&id=_FSc5C2bFYUC&oi=fnd&pg=PR9&dq=age+and+lying+deceit+psychology&ots=_85dKq9gci&sig=f4fjQqQx4oBlyxEtbeBfRhr7ZDk. Accessed 7 Oct 2017

  22. Brener ND, Billy JOG, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents—assessment of factors affecting the validity.pdf. J Adolesc Health. 2003;33:436–57.

    Article  PubMed  Google Scholar 

  23. Tangmunkongvorakul A, Chariyalertsak S, Amico KR, Saokhieo P, Wannalak V, Sangangamsakun T, et al. Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand. AIDS Care. 2013;25(8):961–7.

    Article  PubMed  Google Scholar 

  24. Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007;14(2):56–60.

    PubMed  Google Scholar 

  25. Eiser A, Ellis G. Viewpoint: cultural competence and the African American experience with health care: the case for specific content in cross-cultural education. Acad Med. 2007;82(2):176–83.

    Article  PubMed  Google Scholar 

  26. Corbie-Smith G, Thomas S, George DMMS. Distrust, race, and research. Arch Intern Med. 2002;162(2):2458–63.

    Article  PubMed  Google Scholar 

  27. Zheng J-H, Guida L, Rower C, Castillo-Mancilla JR, Meditz A, Klein B, et al. Quantitation of tenofovir and emtricitabine in dried blood spots (DBS) with LC–MS/MS. J Pharm Biomed Anal. 2014;88(25):144–51.

    Article  CAS  PubMed  Google Scholar 

  28. Castillo-Mancilla JR, Zheng J-H, Rower JE, Meditz A, Gardner EM, Predhomme J, et al. Tenofovir, emtricitabine, and Tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure. AIDS Res Hum Retroviruses. 2012;29(2):384–90.

    PubMed  Google Scholar 

  29. Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2007;12(1):86–94.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was reviewed by the Adolescent Medicine Trials Network for HIV/Aids Intervention’s (ATN) Behavioral Leadership Group. Network operations and data management support were provided by the ATN Data and Operations Center at Westat Inc. We acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Straub, Enriquez-Bruce), Children’s Hospital of Los Angeles (Belzer, Tucker), Children’s National Medical Center (D’Angelo, Trexler), Children’s Hospital of Philadelphia (Douglas, Tanney), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Henry-Reid, Bojan), Montefiore Medical Center (Futterman, Campos), Tulane University Health Sciences Center (Abdalian, Kozina), University of Miami School of Medicine (Friedman, Maturo), St. Jude’s Children’s Research Hospital (Flynn, Dillard), Baylor College of Medicine, Texas Children’s Hospital (Paul, Head); Wayne State University (Secord, Outlaw, Cromer); Johns Hopkins University School of Medicine (Agwu, Sanders, Anderson); The Fenway Institute (Mayer, Dormitzer); and University of Colorado (Reirden, Chambers). We also acknowledge NIH support through NICHD with supplemental funding from NIDA and NIMH. We would like to thank the ATN Community Advisory Board and the youth who participated in the study.

Funding

This study was funded by the National Institute of Allergy and Infectious Diseases (K01AI091861).

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA

    Zoë Baker, Marjan Javanbakht & Pamina Gorbach

  2. Population Council, New York, NY, USA

    Stan Mierzwa & Craig Pavel

  3. Department of Infectious Diseases, Brown University Warren Alpert Medical School, Providence, RI, USA

    Michelle Lally

  4. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Gregory Zimet

  5. Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Pamina Gorbach

Authors
  1. Zoë Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marjan Javanbakht
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stan Mierzwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Craig Pavel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michelle Lally
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gregory Zimet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pamina Gorbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zoë Baker.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baker, Z., Javanbakht, M., Mierzwa, S. et al. Predictors of Over-Reporting HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Young Men Who Have Sex With Men (YMSM) in Self-Reported Versus Biomarker Data. AIDS Behav 22, 1174–1183 (2018). https://doi.org/10.1007/s10461-017-1958-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-1958-4

Keywords

Search

Navigation